History and Definition of Stress Theory

PART I

HISTORY AND DEFINITION OF STRESS THEORY

art I of this book consists of two chapters. The first chapter gives a brief overview of the history of stress theory. The second chapter P attempts to clarify definitions of concepts. CHAPTER 1

The History of Stress Theory

his chapter presents the history of stress theory, a relatively new theory that is still evolving. Although limited to dealing with one T major aspect of clients’ lives, stress theory’s “applicability is far- reaching” (Ingoldsby, Smith, & Miller, 2004, p. 147). The terms stress theory and crisis theory have been used interchangeably. This text uses the term stress theory as the title acknowledges that, although sometimes stress is of crisis proportions, stress is not always of that severity. A theory is an explanation of observations (Babbie, 2004) that can show us how to intervene (Burr, 1995), predict behavior, and guide research. There are different types of theories. Stress theory is a social theory that explains observations about stress, an aspect of social life. Theories use concepts that represent classes of phenomena to explain observations. A variable, a special type of concept that varies, is composed of a set of attributes (Babbie, 2004). The attributes male and female compose the variable gender as gender varies from male to female. When we put together concepts showing their relationships, we form conceptual frameworks or models. Chapters in Part II of this book include conceptual frameworks/models of stress theory. Although stress theory is a relatively new development, most likely people have dealt with stress since the beginning of the human race. Boss (1987) points out that “in the Talmud and the Bible, we read that families have been concerned with events of change, trouble, disaster, and ambiguity since the beginning of recorded time” (p. 696). Early stress researchers in England wrote “considerably on problem families, ▼ 2– Chapter 1 The History of Stress Theory– ▼ –3

labeling them as deviant, antisocial, and lower class” (Hill, 1958, p. 144). Early American researchers, in contrast to English researchers, concen- trated on the processes of family maladjustment rather than on stereo- typing families (Hill, 1958). The late 1970s through the late 1980s saw a shift in research from family weaknesses to family strengths and coping strategies (Burr, 1989). Research on stress not only varied in focus from weaknesses to strengths; it also varied in the unit of analysis from individuals, to families, to communities. In this chapter, a brief history of the development of individual stress theory appears first, followed by the history of the development of family stress theory. Although this text is primarily aimed at people interested in families, individual stress theory has made valuable contributions to understanding family stress (Boss, 2002), and both individual and family stress theories are important in family stress management.

Individual Stress Theory

Contributions to individual stress theory came largely from psychobiology, sociology, psychiatry, and anthropology. The earlier researchers were psychobiologists, followed by sociologists, psychiatrists, and anthropologists. The models briefly discussed in this section are presented in detail in Part II of this text. See Figure 1.1 for a timeline of individual stress theory development. We begin with the contributions of psychobiology.

Figure 1.1 Timeline of Development of Individual Stress Theory

Cannon Tyhurst Caplan Hoff (1929) (1951) (1964) (1984)

1920 1930 1940 1950 1960 1970 1980

Linde- Holmes Sifneos mann and (1960) (1944) Rahe (1967) ▼ 4– –PART I HISTORY AND DEFINITION OF STRESS THEORY

Psychobiology Early psychobiologists found a connection between emotional stress and physiology. Cannon (1929) did early experimental work showing that stimuli associated with emotional arousal led to changes in physiological processes. Later, the relationship between ordinary life events and illness was demonstrated. More recently technological advances facilitated research showing specific physiological responses to stress. Shortly after the work of early psychobiologists, sociologists began contributing to the stress research.

Sociology Lindemann (1944), a sociologist, described individual bereavement experiences of surviving relatives of those who died in the Melody Lounge Cocoanut Grove fire. In studying surviving relatives of the people who per- ished in the fire, he found that those who had positive outcomes had gone through a process. The grieving process that he observed is discussed later in Part III: Crisis Management. Following the work in sociology, psychiatrists contributed to the stress literature.

Psychiatry Early psychiatrists contributing to stress theory included Tyhurst (1951, 1957a, 1957b), Caplan (1964, 1974), Holmes and Rahe (1967), and Sifneos (1960). While Tyhurst (1951, 1957a, 1957b) developed a model describing the natural history of individual reactions to disaster, which are discussed in Part II of this book, Holmes and Rahe (1967) conceived of life events as stressors, which require change in the individual’s ongoing life pattern. Their Social Readjustment Rating Scale (SRRS) (Holmes & Rahe, 1967) appears in Chapter 2. To this day, the scale is used to assess vulnerability of individuals and cited in the literature (e.g., Lewis, Lewis, Daniels, & D’Andrea, 2003). Caplan’s (1974) focus on prevention of mental health disturbances was different from that of Tyhurst (1951, 1957a, 1957b) and Holmes and Rahe (1967). He developed a stage theory of crisis development (Caplan, 1964), which is presented in Part II of this book. Also in Part II of this book, Sifneos’ model, useful in guiding crisis assessment, appears. Although psychiatric models dominated the 1950s and 1960s, the 1980s saw a contribution to stress theory from anthropology.

Anthropology Hoff (1989, 1995, 2001), a nurse anthropologist, developed the Crisis Paradigm to explain what happens when individuals experience crises and Chapter 1 The History of Stress Theory– ▼ –5 to help manage individual crises. The Crisis Paradigm is presented in Part II of this book. Family stress theory developed parallel to the development of individual stress theory.

Family Stress Theory

Independent of the individual stress research summarized above, a considerable body of stress theory and research evolved within the family field (McCubbin, Patterson, & Wilson, 1981). Burr (1989) divided the development of family stress theory into three stages or eras. In this book, I add the fourth era, the postmodern era. The models briefly discussed in the eras are presented in detail in Part II of this text. See Figure 1.2 for a timeline of family stress theory development.

The First Era (1920s to Late 1940s) The first era in the development of family stress theory began with research in the 1920s and ended with efforts toward theory development in the mid-1940s (Burr, 1989). Graduate students did much of the early research in the 1920s while Angell, a sociologist from the University of Michigan, wrote one of the first published studies on family stress in 1936. The research of Cavan and Ranck (1938) from the University of Chicago followed. Both studies examined the effects of the Great Depression of the 1930s on families. Both also studied families on the sociopsychological/family level using the case study approach and induc- tive (specific to general) method to examine the effects of the stressor of the sudden loss or reduction of income on families as well as individuals (Boss, 1987). Angell (1936) found that family integration and adaptability had an impact on how families reacted to the sudden loss of income. He defined integration as the family’s “bonds of coherence and unity” consisting of “common interests, affection, and a sense of economic interdependence” (p. 15) and adaptability as flexibility (vs. rigidity) in a family’s structure. Adaptability consisted of philosophy of life (materialistic vs. nonmaterialistic), family mores (traditional vs. nontraditional), and responsibility (irrespon- sibility vs. responsibility). He called the more adaptable families “plastic” families, which were the nonmaterialistic, nontraditional, responsible families. Angell distinguished three degrees of integration and adaptability pro- ducing nine types of families (highly integrated, highly adaptable; highly integrated, moderately adaptable; highly integrated, inadaptable; moderately integrated, highly adaptable; moderately integrated, moderately adaptable; 2000 Boss (2002) Co rn ille and Boroto (1992) McCubbin and McCubbin (1991) Resiliency Model 1990 Burr (1989) ypology McCubbin and McCubbin (1987) T Model 1980 le atterson AAR atterson McCubbin and P (1983b) F Model McCubbin and P (1982) Doub ABC X 1970 1960 Hill (1958) ABCXX 1950 Hill (1949) Roller Coaster oos K (1946) 1940 k an and v Ca Ranc (1938) Angell (1936) 1930 Timeline of Development Timeline of Family Stress Theory

Graduate students did research 1920 Figure 1.2 ▼ 6– Chapter 1 The History of Stress Theory– ▼ –7 moderately integrated, inadaptable; integrated, highly adaptable; unintegrated, moderately adaptable; and unintegrated, unadaptable). No unintegrated, highly adaptable families were found in the study. Angell found that the families accommodated more easily when there was a maximum of integration and adaptability and that “even a moderate degree of adaptability will pull families with any integration at all through all but the worst crises” (p. 181). Two years following the publication of Angell, Cavan and Ranck (1938) published their findings. Cavan and Ranck (1938), a sociologist and a psychiatric social worker, respectively, presented “a theoretical statement of the process of organization, crisis, disorganization, and reorganization, as related to the family” (p. 2). They applied group theories to the family in stating that three criteria characterized a well-organized (vs. disorganized) family: (a) “a high degree of unity,” (b) “reciprocal functioning,” and (c) “a definite function in the larger community of which it is a part” (p. 2). Evidence of the first characteristic, unity, included the degree of

• acceptance and contribution to family objectives, such as caring for children, planning for children’s education, establishing a permanent home, and providing affectional relations; • subordination of personal ambitions to family objectives; • conduct controlled by accepted family traditions and ideals, not through external compulsion; and • satisfaction for interests (amusement, intellectual stimulation, finances) found within the family.

Cavan and Ranck (1938) defined the second characteristic of organized families, reciprocal functioning, as when family “members have been assigned and have accepted definite roles which are complementary to each other” (pp. 3–4). Evidence of having a function in the community included three characteristics: (a) being self-supporting, (b) abiding by the law, and (c) maintaining friendly relationships with neighbors. Cavan and Ranck (1938) believed that it was important to study family members (individuals) as well as the family as a whole and that it was important for individual members to be well organized. They defined the well- organized family member as one who accepted family and community roles. The person then organized his or her life around those roles. The well- organized person also found socially acceptable and personally satisfactory ways to achieve the goals implied by the roles. Early family stress researchers (Angell, 1936; Cavan & Ranck, 1938) used the term crisis for what we now label stressor in stress theory, leading to some confusion among those studying the theory. Despite this drawback, ▼ 8– –PART I HISTORY AND DEFINITION OF STRESS THEORY

this first body of research led to the first efforts of development of family stress theory (Burr, 1989) by sociologist Earl Koos (1946). Koos made the first effort at creating a stress theory with “the profile of trouble” (p. 107). Koos’s research and profile, which appear in Part II of this book, led to the second era of family stress theory development.

The Second Era (Late 1940s to Late 1970s) The second era, from the late 1940s to the late 1970s, consisted of major theoretical development (Burr, 1989). Hill (1949), another sociologist, called Koos’s (1946) profile of families in trouble the Truncated Roller Coaster Profile of Adjustment. Named the father of family stress theory (Boss, 2002), Hill (1949, 1958) made the next attempt at developing family stress theory when he developed the ABCX “Formula”/Model, which became the center of family stress theory, in this era. According to Boss (1987), Hill (1958) made a substantial contribution to scientific inquiry into family stress with his ABCX Formula, whose variables remain a foundation of current family stress theory. Much of the remainder of this era consisted of testing the ABCX Formula (Burr, 1989). A shift in the focus of research led to the third era of family stress theory development.

The Third Era (Late 1970s to Mid-1980s) From the late 1970s through the late 1980s, the third era saw a change in focus of research from family weaknesses to family strengths, coping strategies, and family system concepts (Burr, 1989). McCubbin and Patterson (1982, 1983a, 1983b), two family social scientists, expanded on the ABCX Formula to develop the Double ABCX Model, which included coping as well as other variables. Family stress researchers in this era based their studies on the Double ABCX Model (Burr, 1989). A shift in focus to processes signaled the beginning of the fourth era in the development of family stress theory.

The Fourth Era (Mid-1980s to Present) The fourth era in the development of family stress theory saw a shift to a more postmodern approach by changing focus to processes, shared family meanings, culture, and contexts as well as family strengths.

Based on the premise that there are multiple realities and multiple truths, postmodern therapies reject the idea that reality is external and can be grasped. People create meaning in their lives through conversations with others. The postmodern approaches avoid Chapter 1 The History of Stress Theory– ▼ –9

pathologizing clients, take a dim view of diagnosis, avoid searching for underlying causes of problems, and place a high value on discovering clients’ strengths and resources. Rather than endless talking about problems, the focus of therapy is on creating solutions in the present and the future. (Corey, 2005, p. 471)

The fourth, postmodern, era of stress theory development began with a focus on shared family meanings created through family member interactions appearing in the Family Adjustment and Adaptation Response (FAAR) Model (McCubbin & Patterson, 1983b; Patterson, 1988, 1989, 1993, 2002; Patterson & Garwick, 1994). In 1987, the husband and wife team of Marilyn McCubbin, a nurse, and Hamilton McCubbin, family social scientist, expanded on the Double ABCX Model to develop the Typology Double ABCX Model, later called the Typology Model of Family Adjustment and Adaptation. The change from concentrating on the causes of stress and family weaknesses to concentrating on family strengths appeared in this era of stress theory development. With this change in concentration, the concept of resilience was added to the stress literature beginning in the late 1980s (Rutter, 1987; Stinnett & DeFrain, 1985). Expanding on the Typology Model of Family Adjustment and Adaptation that they had published in 1987, M. A. McCubbin and H. I. McCubbin (1991, 1993) developed the Resiliency Model of Family Stress, Adjustment, and Adaptation. While adding to the literature, by considering culture and a more postmodern view, the Resiliency Model was still based on the ABCX Formula/Model (Hill, 1949, 1958). Another shift in stress theory development of this era came as focus on processes occurred. Robert Burr (1989), a family scientist, proposed using the general ecosystemic theory to explain family stress. He modified the Profile of Trouble (Koos, 1946) to illustrate the processes that families experience. The Family Distress Model (Cornille & Boroto, 1992; Cornille, Boroto, Barnes, & Hall, 1996; Cornille, Mullis, & Mullis, 2006) also focused on processes and considered culture. Wesley Burr and Associates (1994) called on scholars to “set aside positiv- ist views in favor of a family systems paradigm. . . . They suggested that scholars liberate themselves from the ABCX Model” (Boss, 2002, pp. 33–34). Despite that suggestion, during this era, Boss expanded on the ABCX Formula to develop the Contextual Model of Family Stress, which considered culture. Boss suggested that the postmodern era of family stress theory development began with her model. Regardless of what this era is called or when exactly it began, it saw the development of models focusing on family meanings, family processes, family strengths, and family contexts and models that considered culture, making them more postmodern in approach. ▼ 10– –PART I HISTORY AND DEFINITION OF STRESS THEORY

Summary of the History of Stress Theory

Individual stress theory and family stress theory had parallel developments beginning in the early 1920s. Individual stress theorists came mainly from the fields of psychobiology, sociology, psychiatry, and anthropology. Family stress theorists came mainly from sociology, psychiatric social work, nursing, and family science. The development of family stress theory occurred in four eras. Part II of this book presents stress theory models. In the models there are inconsistencies in definitions of concepts. For example, early family stress researchers used the term crisis for what we now label stressor in stress theory, leading to some confusion among those studying the theory. Because of this and other varying definitions of concepts, definitions are presented in Chapter 2.

References and Suggestions for Further Reading

Angell, R. C. (1936). The family encounters the depression. Gloucester, MA: Peter Smith. (Reprinted in 1965) Babbie, E. (2004). The practice of social research (10th ed.). Belmont, CA: Wadsworth/Thomson. Boss, P. (1987). Family stress. In M. B. Sussman & S. K. Steinmetz (Eds.), Handbook of marriage and the family (pp. 695–723). New York: Plenum Press. Boss, P. (2002). Family stress management: A contextual approach (2nd ed.). Thousand Oaks, CA: Sage. Burr, R. G. (1989). Reframing family stress theory: From the ABC-X Model to a Family Ecosystemic Model. Unpublished master’s thesis, Brigham Young University, Provo, UT. Burr, W. R. (1995). Using theories in family science. In R. D. Day, K. R. Gilbert, B. H. Settles, & W. R. Burr (Eds.), Research and theory in family science (pp. 73–88). Pacific Grove, CA: Brooks/Cole. Burr, W. R., Klein, S. R., & Associates. (1994). Reexamining family stress: New theory and research. Thousand Oaks, CA: Sage. Cannon, W. B. (1929). Bodily changes in pain, hunger, fear and rage. New York: D. Appleton & Co. Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books. Caplan, G. (1974). Support systems and community mental health. New York: Behavioral Publications. Cavan, R. S., & Ranck, K. H. (1938). The family and the depression: A study of one hundred Chicago families. Chicago: The University of Chicago Press. Corey, G. (2005). Theory and practice of counseling & psychotherapy (7th ed.). Belmont, CA: Thomson Brooks/Cole. Cornille, T. A., & Boroto, D. R. (1992). The Family Distress Model: A conceptual and clinical application of Reiss’ strong bonds finding. Contemporary Family Therapy, 14(3), 181–198. Chapter 1 The History of Stress Theory– ▼ –11

Cornille, T. A., Boroto, D. R., Barnes, M. F., & Hall, P. K. (1996). Dealing with family distress in schools. Families in Society: The Journal of Contemporary Human Services, 77(7), 435–445. Cornille, T. A., Mullis, A. K., & Mullis, R. L. (2006, November). How to use Internet coverage about disasters to teach about family resilience. PowerPoint presented at the meeting of the National Council on Family Relations, Minneapolis, MN. Hill, R. (1949). Families under stress. New York: Harper & Brothers. Hill, R. (1958). Generic features of families under stress. Social Casework, 49, 139–150. Hoff, L. A. (1984). People in crisis: Understanding and helping (2nd ed.). Menlo Park, CA: Addison Wesley. Hoff, L. A. (1989). People in crisis: Understanding and helping (3rd ed.). Menlo Park, CA: Addison Wesley. Hoff, L. A. (1995). People in crisis: Understanding and helping (4th ed.). Menlo Park, CA: Addison Wesley. Hoff, L. A. (2001). People in crisis: Clinical and public health perspectives (5th ed.). San Francisco: Jossey-Bass. Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213–218. Ingoldsby, B. B., Smith, S. R., & Miller, J. E. (2004). Exploring family theories. Los Angeles: Roxbury. Koos, E. L. (1946). Families in trouble. Morningside Heights, NY: King’s Crown. Lewis, J. A., Lewis, M. D., Daniels, J. A., & D’Andrea, M. J. (2003). Community counseling: Empowerment strategies for a diverse society (3rd ed.). Pacific Grove, CA: Thomson Brooks/Cole. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141–148. McCubbin, H. I., & Patterson, J. M. (1982). Family adaptation to crises. In H. I. McCubbin, A. Cauble, & J. Patterson (Eds.), Family stress, coping, and social support (pp. 26–47). Springfield, IL: Charles C. Thomas. McCubbin, H. I., & Patterson, J. M. (1983a). Family stress and adaptation to crises: A Double ABCX Model of family behavior. In D. H. Olson & R. C. Miller (Eds.), Family studies review yearbook: Vol. 1 (pp. 87–106). Beverly Hills, CA: Sage. McCubbin, H. I., & Patterson, J. M. (1983b). The family stress process: The Double ABCX Model of family adjustment and adaptation. In H. I. McCubbin, M. Sussman, & J. M. Patterson (Eds.), Social stress and the family: Advances and developments in family stress theory and research (pp. 7–37). New York: Haworth. McCubbin, H. I. Patterson, J. M., & Wilson, L. R. (1981). FILE: Family Inventory of Life Events and Changes: Research instrument. St. Paul: Family Social Science, University of Minnesota. McCubbin, M. A., & McCubbin, H. I. (1987). Family stress theory and assessment: The T-double ABCX Model of family adjustment and adaptation. In H. I. McCubbin & A. Thompson (Eds.), Family assessment inventories for research and practice (pp. 3–32). Madison: University of Wisconsin. ▼ 12– –PART I HISTORY AND DEFINITION OF STRESS THEORY

McCubbin, M. A., & McCubbin, H. I. (1991). Family stress theory and assessment: The Resiliency Model of Family Stress Adjustment and Adaptation. In H. I. McCubbin & A. Thompson (Eds.), Family assessment inventories for research and practice (pp. 3–31). Madison: University of Wisconsin. McCubbin, M. A., & McCubbin, H. I. (1993). Families coping with illness: The Resiliency Model of Family Stress Adjustment and Adaptation. In C. Danielson, B. Hamel-Bissell, & P. Winstead-Fry (Eds.), Families, health & illness: Pers pectives on coping and intervention (pp. 21–64). St. Louis, MO: Mosby. Patterson, J. M. (1988). Families experiencing stress: I. The Family Adjustment and Response Model, II. Applying the FAAR Model to health-related issues for intervention and research. Family Systems Medicine, 6(2), 202–237. Patterson, J. M. (1989). A family stress model: The Family Adjustment and Adaptation Response. In C. Ramsey (Ed.), The science of family medicine (pp. 95–117). New York: Guilford Press. Patterson, J. M. (1993). The role of family meanings in adaptation to chronic illness and disability. In J. M. Patterson, A. P. Turnbull, S. K. Behr, D. L. Murphy, & J. G. Marquis (Eds.), Cognitive coping, families, and disability (pp. 221–238). Baltimore: Brookes. Patterson, J. M. (2002). Integrating family resilience and family stress theory. Journal of Marriage and Family, 64, 349–360. Patterson, J. M., & Garwick, A. W. (1994). Levels of meaning in family stress theory. Family Process, 33, 287–304. Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57(3), 316–331. Sifneos, P. E. (1960). A concept of “emotional crisis.” Mental Hygiene, 44, 169–179. Stinnett, N., & DeFrain, J. (1985). Secrets of strong families. Boston: Little, Brown. Tyhurst, J. S. (1951). Individual reactions to community disaster: The natural history of psychiatric phenomena. American Journal of Psychiatry, 107, 764–769. Tyhurst, J. S. (1957a). Psychological and social aspects of civilian disaster. Canadian Medical Association Journal, 76, 385–393. Tyhurst, J. S. (1957b). The role of transition states—including disaster—in mental illness. In Symposium on preventive and social psychiatry (pp. 149–169). Washington, DC: Walter Reed Army Institute of Research and the National Research Council.